Healthcare Provider Details

I. General information

NPI: 1467458786
Provider Name (Legal Business Name): MARIA CHRISTINA COYLE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA CHRISTINA PRUCHNICKI PHARM.D.

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 W 10TH AVE # 1970A
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

500 W 12TH AVE RM 455
COLUMBUS OH
43210-1214
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-5075
  • Fax: 614-293-3171
Mailing address:
  • Phone: 614-292-1363
  • Fax: 614-292-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-1-19124
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: